One of the most consistent findings in both cultural psychiatry and outcome research in schizophrenia is that outcomes of schizophrenia are better in developing countries than in developed ones. Yet, little is known about why this is the case. The proposed project is a first step towards building a sustained research program that will reveal the mechanisms underlying the cross-cultural variation in psychosis outcomes. Specifically, the project involves collaboration between leading schizophrenia research teams, with complementary strengths in culturally relevant schizophrenia research in India and pioneering first-episode psychosis research in Canada. Previous investigations of cross-cultural variation in outcomes of psychosis have often been limited by confounding factors such as differences in duration of untreated psychosis and treatments received. The proposed study avoids this pitfall by focusing on first-episode patients who have not been treated before. Over the proposed two-year funding period, a well characterized sample of patients with previously untreated first- episode psychosis will be followed in India and Canada and treatment interventions will be clearly defined. The premise of the pilot studies to be undertaken is that family factors positively impact the course of schizophrenia in India, buffering the toxic effects of untreated psychosis prior to detection and reinforcing the effects of treatment after detection. The specific hypotheses to be tested are (1) Duration of untreated psychosis will have a less detrimental effect on clinical outcomes in India than in Canada. Differences between family support available to patients in India and Canada will account for the less pernicious effect of delay in treatment. (2) Duration of untreated psychosis in India itself will be predicted by family factors such as previous family experience with mental illness and the type of family structure (nuclear versus extended). Individuals in extended families and in families with lower levels of prior experience with mental illness will have longer duration of untreated psychosis. (3) Family factors will significantly predict six-month and one-year clinical and occupational outcomes in India. Results will increase our understanding of what it is that families do that contributes to better outcomes in India. Such an understanding will lead to the development of culturally appropriate family interventions and strategies to reduce treatment delay in India. In the course of collaborating to conduct these pilot studies, the Indian site will also build its capacity to conduct long-term research in early psychosis. Such research can inform the development of policies and clinical services that can address the severe burden of schizophrenia on people in developing countries who face acute shortage of resources. PUBLIC HEALTH RELEVANCE: This study seeks to strengthen the research collaboration between a developed country, Canada and a developing country, India for the purpose of understanding why schizophrenia has different outcomes in different cultural settings. This project will increase the understanding of the role of families in seeking and facilitating treatment, and thus help the development of early intervention and family services. An important outcome of this project will be the building of culturally appropriate and sustainable research capacity in a developing country and thereby the improvement of services for people with schizophrenia across the world.